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When a patient on peritoneal dialysis (PD) presents with suspected PD-related peritonitis (e.g. cloudy PD fluid and abdominal pain), one of the most important initial aspects of management is for the nephrology nurse/home dialysis nurse to collect PD effluent specimens for white blood cells count, Gram stain, culture and sensitivity for inspection and to send for laboratory testing before antibiotics are started. A review by seven members of the International Society for Peritoneal Dialysis (ISPD) Nursing Committee of all 133 questions posted to the ISPD website 'Questions about PD' over the last 4 years (January 2018-December 2021), revealed 97 posted by nephrology nurses from around the world. Of these 97 questions, 10 were noted to be related to best practices for PD effluent specimen collection. For our review, we focused on these 10 questions along with their responses by the members of the ISPD 'Ask The Experts Team', whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practice discussed. We revised the original responses for clarity and updated the references. We found that these 10 questions were quite varied but could be organised into four categories: how to collect PD effluent safely; how to proceed with PD effluent collection; how to collect PD effluent for assessment; and how to proceed with follow-up PD effluent collection after intraperitoneal antibiotics have been started. In general, we found that there was limited evidence in the PD literature to answer several of these 10 questions posted to the ISPD website 'Questions about PD' by nephrology nurses from around the world on this important clinical topic of best practices for PD effluent specimen collection. Some of these questions were also not addressed in the latest ISPD Peritonitis Guidelines. Moreover, when polling members of our ISPD Nursing Committee we found when answering a few of these questions, nursing practice varied within and among countries. We encourage PD nurses to conduct their own research on this important topic, focusing on areas where research evidence is lacking.

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Pineal microdialysis is characterized by the real-time monitoring of melatonin, neurotransmitters, metabolites, and other compounds released by the pineal gland throughout 24 h. It is a technique with great advantages that allows in vivo study of the ongoing pineal gland metabolism. In this chapter, we describe the entire process of pineal microdialysis that includes probe manufacturing, surgical procedure for its implantation, and the sample collection process.

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AIMS: To evaluate the physicochemical and microbiological quality of dialysis water and dialysate samples from haemodialysis centres. METHODS AND RESULTS: Samples were fortnightly collected from three haemodialysis centres in Bauru City, Brazil, between July 2017 and June 2018, at the stages of post-reverse osmosis, reuse and dialysate. Analyses included determination of conductivity, fluoride, nitrate and sulphate; test for total coliform bacteria; count of heterotrophic bacteria; count and identification of non-fermenting gram-negative bacilli (NFGNB); drug susceptibility test; biofilm formation capacity; and genetic similarity among some isolated NFGNB. Of the analysed samples, only 4/72 (5.6%) had conductivity values ≥10 mS/cm, 4/216 (1.9%) presented total coliforms and 1/216 (0.5%) had heterotrophic bacteria count >100 CFU/ml. NFGNB were isolated from 99/216 (45.8%) samples, and the major identified micro-organisms included Herbaspirillum aquaticum/huttiense, Brevundimonas aurantiaca, Cupriavidus metallidurans, Pseudomonas aeruginosa and Ralstonia insidiosa. Isolates of P. aeruginosa and Burkholderia cepacia complex were sensitive to most antimicrobials and, together with isolates of Ralstonia insidiosa and Ralstonia pickettii, showed strong biofilm formation capacity. Some isolates expressed the same electrophoretic profile on pulsed-field gel electrophoresis, indicating the persistence of bacterial clones in the systems over time. CONCLUSIONS: NFGNB were observed in several dialysis water and dialysate samples from all investigated centres, which may represent a risk to the health of patients. SIGNIFICANCE AND IMPACT OF THE STUDY: Regular inclusion of actions for NFGNB control and monitoring in haemodialysis fluids are suggested for greater safety of the dialytic process.

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We studied the polyphenol profile and antioxidant properties of cooked whole-wheat pasta to evaluate its effective antioxidant capacity, including changes produced by its production and in vitro digestion. The polyphenol profile was studied by HPLC-ESI-MS/MS, while the antioxidant capacity was measured by TEAC and FRAP assays. Results show that the polyphenol profile and antioxidant capacity change along the elaboration of cooked pasta, being the cooking step important to increase the release of bound polyphenols, enhancing their antioxidant properties. On the other hand, the study of the bioaccessibility of polyphenols, using an experimental model that simulates human gastrointestinal digestion and subsequent absorption, showed that only a small fraction of the starting polyphenolic compounds, mainly free polyphenols, could be absorbed by the small intestine; thus, reducing their effective antioxidant capacity. To our knowledge, this is the first report showing the bioaccessibility of hydroxybenzoic acid glucoside, hydroxybenzoic acid diglucoside, tryptophan, 6-C-glucosyl-8-C-arabinosyl-apigenin and diferulic acids.

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Hemodialysis, which is a kidney failure treatment that uses hemodialysis machine, dialyzer, dialysis solution, catheters, and needles, favors biofilm formation. This study evaluates whether Aspergillus, Candida, and Fusarium can form biofilm in dialysis fluids. Biofilms were grown in 96-well microplates containing solutions (acid and basic) consisting of dialysate, dialysate per se, or dialysate plus glucose as culture medium. The biofilms were incubated at 30 °C for 72 h, quantified by the violet crystal methodology, and visualized by transmission electron microscopy. All the fungi formed biomass in all the tested solutions. However, Bonferroni analysis revealed that the dialysate facilitated Aspergillus biomass development, whereas the dialysate and dialysate with glucose provided similar Fusarium oxysporum biomass development. Candida parapsilosis development was favored in biofilms grown in basic electrolytic solution. Electron micrographs of biofilms that grew on catheters after 72 h showed that Aspergillus formed abundant hyphae; the extracellular matrix was visible on the surface of some hyphae when Aspergillus was grown in the dialysate. A multilayered hyphal structure emerged when F. oxysporum biofilms were incubated in the dialysate with glucose. C. parapsilosis biofilm growth in basic solution elicited a dense network of yeasts and pseudohyphae as well as the extracellular matrix; the biofilm was attached across the catheter length. This study may contribute to the formulation of new strategies to monitor biofilm formation and to increase knowledge associated with fungal biofilms in the dialysis environment.

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BACKGROUND/AIMS: Hyperphosphatemia is associated with high mortality rate in patients on dialysis. Conventional hemodialysis (HD) is a limit technique in removing phosphate (P). There is a widespread belief that P is removed mainly in the first hour of HD. The aim of this study was to certify the percentage of 1-hour removal of P as compared to the entire procedure. METHODS: data from the first dialysis of the week of 21 patients (13 men, age 44±15 years), for 3 consecutive dialysis sessions were evaluated. Fresh dialysate samples were collected at 1 hour and at the end of the session from a partial spent dialysate collection method. RESULTS: Pre dialysis serum P was 4.7±1.7 mg/dl. Reduction rate of serum P was 47.4 ± 14.3 and 45.1 ± 10.8% in 1- and 4-hour of HD, respectively (p=0.322). P removal was 194 (145, 242) mg in 1-hour (p<0.0001), which represents 25.0 ± 0.2% of the total removed during the entire HD. Patients with pre dialysis P ≥ 5.5mg/dl had higher P removal during HD than those with P < 5.5mg/dl [975 (587, 1354) vs. 776 (580, 784) mg, p=0.025], although the percentage of removal in 1 hour was not different from those with P < 5.5mg/d (24.9 ± 0.3 vs. 25.0 ± 0.1%, p=0.918). P removal during dialysis correlated with pre dialysis serum P (r=0.455, p=0.001), parathormone (r=0.264, p=0.037) and ultrafiltration volume (r=0.343, p=0.019). CONCLUSION: despite the P serum concentration normalizing in the first hour of hemodialysis, the removal in the same period reaches only 25% of the entire session.

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Systemic anticoagulation with unfractionated heparin is commonly used in maintenance hemodialysis (HD), but it increases the risk of bleeding complications. We investigated whether the use of citrate-enriched bicarbonate based dialysate (CD) would reduce systemic anticoagulation without compromising the efficacy of reprocessed dialyzers. This is a crossover study in which half of a total of 30 patients initially underwent HD with acetate-enriched bicarbonate based dialysate and a standard heparin dose of ∼ 100 IU/kg (Treatment A), whereas the remaining patients were treated with CD and a 30% reduced heparin dose (Treatment B). After 12 consecutive HD sessions in each treatment, the dialysate and heparin doses were reversed, then followed for another period of 12 HD sessions. The two treatment phases were split by a washout period of six HD sessions using acetate-enriched bicarbonate based dialysate and standard heparin dose. Systemic anticoagulation was higher in Treatment A. The activated partial thromboplastin time at the end of HD session was 68 ± 36 seconds in Treatment A and 47 ± 16 seconds in Treatment B (P = 0.005). Sixty-eight percent of the dialyzers remained adequate until the 12th use in Treatment A and 61% did so in Treatment B (P = 0.63). Patients had three and 24 cramps episodes during Treatment A and B, respectively (P < 0.001). Nine and 26 symptomatic intradialytic hypotension episodes were seen in Treatment A and B, respectively, (P = 0.003). In conclusion, the use of CD had a favorable effect on anticoagulation in the extracorporeal circuit in patients on maintenance HD, but it was also associated with more hypotension and cramps.

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A Diálise Peritoneal (DP) é uma modalidade dialítica que remove os solutos urêmicos pelo peritônio, o qual funciona como uma membrana semipermeável. Suas indicações em cães e gatos são peritonite, pancreatite, insuficiência cardíaca congestiva, intoxicações e, principalmente, doença renal aguda ou crônica, em que a concentração sérica de uréia for maior que 100 mg/dl e/ou se a concentração de creatinina for maior que 10 mg/dl. Existem várias técnicas de DP, porém a mais apropriada para cães e gatos é a ambulatorial contínua (DPAC). Embora a DP seja uma opção terapêutica efetiva para as mais diversas afecções, sua prática é pouca difundida na rotina clínica, e os estudos que abordam seus aspectos técnicos em pequenos animais são escassos. Desta forma, o presente trabalho objetiva revisar os princípios básicos da Diálise Peritoneal, e sua utilização em cães e gatos.

Peritoneal dialysis (PD) removes the uremic solutes by diffusion across the peritoneum which acts as a semipermeable membrane. Its indications in dogs and cats are peritonitis, pancreatitis, heart failure, intoxication and especially acute or chronic renal disease, wherein the serum concentration of urea is greater than 100 mg/dl and / or the concentration of creatinine is greater 10 mg/dl. There are several techniques of PD, but the most appropriate for dogs and cats is the continuous ambulatory peritoneal dialysis (CAPD). Although PD is an effective therapeutic option for many different diseases it hasn't been practice in clinical routine. Studies about PD technique in small animals are scarce. Thus, this study aims to review the main aspects of PD, and its use in dogs and cats.

La diálisis peritoneal (DP) es una modalidad de diálisis que elimina solutos urémicos por difusión a través del peritoneo, que actúa como una membrana semipermeable. Sus indicaciones en perros y gatos son peritonitis, pancreatitis, insuficiencia cardíaca congestiva, intoxicación y enfermedad renal especialmente aguda o crónica, cuando la concentración sérica de urea es superior a 100 mg/dl y/o la concentración de creatinina es mayor a 10 mg/dl. Existen varias técnicas de DP, pero la más adecuada para los perros y gatos es la ambulatorial continua (DPAC). Aunque la DP es una opción terapéutica eficaz para muchas enfermedades diferentes, su práctica está poco extendida en la práctica clínica, y estudios relacionados con los aspectos técnicos de los pequeños animales son escasos. Por lo tanto, este trabajo tiene como objetivo revisar los principios básicos de la Diálise Peritoneal, y su uso en perros y gatos.

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Hyperchloremia is one of the multiple etiologies of metabolic acidosis in hemodialysis (HD) patients. The aim of the present study was to determine the influence of chloride dialysate on metabolic acidosis control in this population. We enrolled 30 patients in maintenance HD program with a standard base excess (SBE) ≤2 mEq/L and urine output of less than 100 mL/24 h. The patients underwent dialysis three times per week with a chloride dialysate concentration of 111 mEq/L for 4 weeks, and thereafter with a chloride dialysate concentration of 107 mEq/L for the next 4 weeks. Arterial blood was drawn immediately before the second dialysis session of the week at the end of each phase, and the Stewart physicochemical approach was applied. The strong ion gap (SIG) decreased (from 7.5 ± 2.0 to 6.2 ± 1.9 mEq/L, P = 0.006) and the standard base excess (SBE) increased after the use of 107 mEq/L chloride dialysate (from -6.64 ± 1.7 to -4.73 ± 1.9 mEq/L, P < 0.0001). ∆SBE was inversely correlated with ∆SIG during the phases of the study (Pearson r = -0.684, P < 0.0001) and there was no correlation with ∆chloride. When we applied the Stewart model, we demonstrated that the lower concentration of chloride dialysate interfered with the control of metabolic acidosis in HD patients, surprisingly, through the effect on unmeasured anions.

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A redução dos níveis de vitamina D e a retenção de fósforo na doença renal crônica estimulam a proliferação celular da paratireóide, enquanto a liberaçãoaguda de PTH pela glândula é mais dependente do nível de cálcio ionizado no líquido extracelular. Os balanços de fósforo e de cálcio nos pacientes emdiálise assim como a influência que exercem sobre a função da paratireóide e a remodelação óssea são modificáveis por alguns medicamentos como osquelantes de fósforo e a vitamina D e, também, pela prescrição da diálise. Em especial, a concentração de cálcio no dialisato, tanto na hemodiálise quantona diálise peritoneal, pode ter um papel importante no manuseio do hiperparatireoidismo secundário.

Low vitamin D levels and phosphorus retention stimulate parathyroid cell proliferation in chronic kidney disease, whereas acute glandular PTH release is mainly dependent on ionized calcium concentration in the extracellular fluid. Phosphorus and calcium balance in patients on dialysis and their effects on parathyroid function and bone turnover can be influenced by medications such as phosphate binders and vitamin D as well as by dialysis prescription. Of note, the calcium concentration in dialysis solution, on either hemodialysis or peritoneal dialysis can have a special role in the management of renal osteodystrophy.

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In Brazil, 90% of patients with renal failure depend on the hemodialysis procedures in order to remove the metabolic degradation products, water and mineral salts excesses from the organism, restoring the electrolyte and acid-base balance. Water is the main component of the dialysis therapy, and its chemical and microbiology quality is essential to avoid additional risks to patient. Dialysis solutions and equipments provide suitable environments for the microbial growth, particularly Gram-negative bacteria. In addition to bacteremia, Gram-negative microorganisms can be related to pyrogenic reactions. The objective of this study was to investigate the occurrence of non-fermenting Gram-negative bacteria in 97 dialysis water samples, and 27 dialysates analyzed from June 2005 to December 2006. Non-fermenting Gram-negative bacteria were detected in 29.6% of dialysates and in 49.5% of treated water samples. Nine bacteria species were isolated and identified; the Burkholderia cepacia complex was the most frequent (59.0%), followed by Stenotrophomonas maltophilia (13.1%).

No Brasil, 90% dos pacientes renais crônicos dependem dos procedimentos de hemodiálise para remover produtos de degradação metabólica, excesso de água e de sais minerais do organismo, e para restaurar o equilíbrio ácido-base e eletrolítico. A água é o principal componente do tratamento por diálise e suas qualidades química e microbiológica são essenciais para evitar riscos adicionais ao paciente. As soluções para diálise e os equipamentos proporcionam ambientes adequados ao desenvolvimento microbiano, especialmente bactérias Gram-negativas. Além de bacteremias, os microrganismos Gram-negativos podem estar relacionados à ocorrência de reações pirogênicas. Este estudo teve por objetivo verificar a ocorrência de bactérias Gram-negativas não fermentadoras de glicose em 97 amostras de água tratada para diálise e 27 amostras de dialisatos, avaliadas entre junho de 2005 e dezembro de 2006. As bactérias Gram-negativas não fermentadoras de glicose foram detectadas em 29,6% das amostras de dialisatos e em 49,5% das amostras de água tratada. Nove espécies foram isoladas e identificadas, sendo a mais freqüente o complexo Burkholderia cepacia (59,0%), seguido de Stenotrophomonas maltophilia (13,1%).

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Introdução: A melhor forma de quantificar a dose de diálise em pacientes com insuficiência renal aguda (IRA) ainda não está estabelecida. O b j e t i v o s :Avaliar a dose de diálise recebida pela maneira tradicional (PRU e Kt/V) e através da quantificação direta do dialisato em pacientes com IRA. M é t o d o s :A dose de diálise foi quantificada pelo percentual de redução de uréia (PRU), Kt/V (spKt/V e eKt/V) e massa extraída de uréia no dialisato (coleta parcialpor dispositivo automatizado) em pacientes com IRA submetidos à hemodiálise prolongada em unidade de terapia intensiva (UTI). Pacientes cominsuficiência renal crônica (IRC) em programa de diálise serviram como grupo controle. Resultados: Foram realizadas 11 sessões de hemodiáliseprolongada em 8 pacientes com IRA e 8 sessões de hemodiálise convencional em 5 pacientes com IRC. O PRU foi maior nos pacientes com IRC (67%;62-74% v s 54%; 37-57%; P<0,01), assim como o spKt/V (1,31;1,15-1,62 vs 0,90;0,55-1,01; P<0,01) e o eKt/V (1,15; 1,03-1,44 vs 0,69;0,47-0,92; P<0,01).Não houve diferença com relação à massa extraída de uréia no dialisato entre as sessões de hemodiálise convencional (32,6 g; 24,4-56,1) e prolongada(31,8 g; 18,2-88,8). Conclusões: Apesar da maior dose de diálise recebida nos pacientes com IRC, quando avaliada pelo PRU e Kt/V, não houvediferença na massa extraída de uréia no dialisato. Possivelmente, os valores de normalidade definidos pelo método clássico de cinética de uréia parapacientes com IRC não se aplicam a pacientes com IRA e a aferição da dose de diálise pelo dialisato pode ser uma alternativa viável nestes pacientes.

Introduction: The best way for dialysis quantification in patients with acute renal failure (ARF) is not defined. Objectives: Evaluate the delivered dialysisdose by the traditional methods (URR and Kt/V) and by the direct dialysate quantification in patients with acute renal failure. Methods: The dialysis dosewas measured by urea reduction rate (URR), Kt/V (spKt/V, eKt/V) and urea extracted mass in the dialysate (partial dialysate collection by automatic device)in acute renal failure (ARF) patients submitted to extended dialysis in intensive care unit (ICU). Chronic renal failure (CRF) patients were the control group.Results: Eleven extended hemodialysis sessions in eight patients with ARF and eight conventional hemodialysis sessions in five CRF patients wereevaluated. The URR was higher in CRF patients (67%; 62-74% vs 54%; 37-57%; P<0.01) as the spKt/V (1.31;1.15-1.62 vs 0.90;0.55-1.01; P<0.01) andeKt/V (1.15; 1.03-1.44 vs 0.69;0.47-0.92; P<0.01). There was no difference regarding the urea extracted mass in the dialysate in the conventional (32.6 g;24.4-56.1) and extended hemodialysis (31.8 g; 18.2-88.8). Conclusions: In spite of CRF patients have received a higher dialysis dose when evaluated byURR and Kt/V, there was no difference in the urea extracted mass in the dialysate. The classical urea kinetic model may be not applicable for ARF patientsand the evaluation of the dialysate can be an alternative for measurement of dialysis dose in these patients.

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